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General NPI Number Information
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NPI Number | 1700827268
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Entity Type | Individual
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Provider Name | SAMUEL KLEIN ROTH PA
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 105 SW CARY PKWY SUITE 300
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City | CARY
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State | NC
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Zip | 27511-5600
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Country | US
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Telephone | 919-467-3203
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Fax | 919-459-5401
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Provider Business Mailing Address
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Address Line | 105 SW CARY PKWY SUITE 300
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City | CARY
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State | NC
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Zip | 27511-5600
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Country | US
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Telephone | 919-467-3203
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Fax | 919-459-5401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 101361
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License Number State | NC
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